The unfinished agenda of communicable diseases among children and adolescents before the COVID-19 pandemic, 1990-2019: a systematic analysis of the Global Burden of Disease Study 2019

BACKGROUND: Communicable disease control has long been a focus of global health policy. There have been substantial reductions in the burden and mortality of communicable diseases among children younger than 5 years, but we know less about this burden in older children and adolescents, and it is unclear whether current programmes and policies remain aligned with targets for intervention. This knowledge is especially important for policy and programmes in the context of the COVID-19 pandemic. We aimed to use the Global Burden of Disease (GBD) Study 2019 to systematically characterise the burden of communicable diseases across childhood and adolescence. METHODS: In this systematic analysis of the GBD study from 1990 to 2019, all communicable diseases and their manifestations as modelled within GBD 2019 were included, categorised as 16 subgroups of common diseases or presentations. Data were reported for absolute count, prevalence, and incidence across measures of cause-specific mortality (deaths and years of life lost), disability (years lived with disability [YLDs]), and disease burden (disability-adjusted life-years [DALYs]) for children and adolescents aged 0-24 years. Data were reported across the Socio-demographic Index (SDI) and across time (1990-2019), and for 204 countries and territories. For HIV, we reported the mortality-to-incidence ratio (MIR) as a measure of health system performance. FINDINGS: In 2019, there were 3·0 million deaths and 30·0 million years of healthy life lost to disability (as measured by YLDs), corresponding to 288·4 million DALYs from communicable diseases among children and adolescents globally (57·3% of total communicable disease burden across all ages). Over time, there has been a shift in communicable disease burden from young children to older children and adolescents (largely driven by the considerable reductions in children younger than 5 years and slower progress elsewhere), although children younger than 5 years still accounted for most of the communicable disease burden in 2019. Disease burden and mortality were predominantly in low-SDI settings, with high and high-middle SDI settings also having an appreciable burden of communicable disease morbidity (4·0 million YLDs in 2019 alone). Three cause groups (enteric infections, lower-respiratory-tract infections, and malaria) accounted for 59·8% of the global communicable disease burden in children and adolescents, with tuberculosis and HIV both emerging as important causes during adolescence. HIV was the only cause for which disease burden increased over time, particularly in children and adolescents older than 5 years, and especially in females. Excess MIRs for HIV were observed for males aged 15-19 years in low-SDI settings. INTERPRETATION: Our analysis supports continued policy focus on enteric infections and lower-respiratory-tract infections, with orientation to children younger than 5 years in settings of low socioeconomic development. However, efforts should also be targeted to other conditions, particularly HIV, given its increased burden in older children and adolescents. Older children and adolescents also experience a large burden of communicable disease, further highlighting the need for efforts to extend beyond the first 5 years of life. Our analysis also identified substantial morbidity caused by communicable diseases affecting child and adolescent health across the world. FUNDING: The Australian National Health and Medical Research Council Centre for Research Excellence for Driving Investment in Global Adolescent Health and the Bill & Melinda Gates Foundation

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND: Disorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021. METHODS: We estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined. FINDINGS: Globally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer. INTERPRETATION: As the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

The effects of a raw vegetarian diet from a clinical perspective; review of the available evidence

Summary: Vegetarianism is defined as a dietary pattern that is based on abstaining from the consumption of animal products. According to this dietary pattern processed foods have been considered unhealthy, and the consumption of raw plant-based diets and un-processed foods has been encouraged, however, these effects have not been fully proven and there are contradictions. The aim of the current study was to conduct a systematic literature review of the available evidence to assess and investigate the effects of a raw vegetarian diet with a review of clinical trial studies. The literature search to find related studies were performed through three scientific databases, including PubMed, SCOPUS, and Google Scholar with related keywords. Based on our findings from the literature, a raw vegan diet with more than 90% raw food cannot be recommended for a long time due to micronutrient deficiencies as well as related complications. In order to investigate possible advantages and disadvantages, it seems well-designed clinical trials are necessary to clarify these effects

Controlling childhood obesity: A systematic review on strategies and challenges

Background: Childhood obesity is a global health problem with short- and long-term health consequences. This systematic review presents a summary of the experiences on different family-, school-, and clinic-based interventions. Materials and Methods: Electronic search was conducted in MEDLINE, PubMed, ISI Web of Science, and Scopus scientific databases. We included those studies conducted among obese individuals aged up to 18 years. Our search yielded 105 relevant papers, 70 of them were conducted as high quality clinical trials. Results: Our findings propose that school-based programs can have long-term effects in a large target group. This can be related to this fact that children spend a considerable part of their time in school, and adopt some parts of lifestyle there. They have remarkable consequences on health behaviors, but as there are some common limitations, their effects on anthropometric measures are not clear. Due to the crucial role of parents in development of children′s behaviors, family-based interventions are reported to have successful effects in some aspects; but selection bias and high dropout rate can confound their results. Clinic-based interventions revealed favorable effects. They include dietary or other lifestyle changes like increasing physical activity or behavior therapy. It seems that a comprehensive intervention including diet and exercise are more practical. When they have different designs, results are controversial. Conclusion: We suggest that among different types of interventional programs, a multidisciplinary approach in schools in which children′s family are involved, can be the best and most sustainable approach for management of childhood obesity

عوامل موثر بر قصد مصرف نوشیدنی‌های شیرین شده در دانش‌آموزان ابتدایی شهر اراک: کاربردی از نظریه رفتار برنامه‌ریزی شده

Background and Aims: Excessive consumption of sugar-sweetened beverages among elementary school students is increasing. This is related to adverse health consequences, in particular the occurrence of chronic diseases in adulthood. Understanding the predictors of reducing the intention to consume these drinks makes it possible to design more effective interventions. The present study was conducted with the purpose of determining the factors affecting the intention to consume sugar-sweetened beverages in primary school students using the theory of planned behavior. Materials and Methods: This cross-sectional-analytical study was conducted on 300 elementary school students in Arak city. Students were selected by cluster sampling. The number of consumed glasses of sugar-sweetened beverages per day by students and their mothers as well as the structures of the theory of planned behavior were assessed using the researcher-made questionnaire to determine the most effective predictors of the intention to reduce the consumption of sugar-sweetened beverages in students. The results were analyzed by linear regression test. Ethical considerations were observed in all stages of the study. Results: The mean age of the students was 11.14±1.26 years and their consumption of sugar-sweetened was 3.86±2.59 glasses per day. Perceived behavioral control (p < 0.001, β = 0.55) and subjective norms (p < 0.001, β = 0.25) were predictors of intention to reduce the consumption of sugar-sweetened beverages. These variables were able to predict 49% of the variance of the intention to reduce the consumption of sugar-sweetened beverages. Conclusion: The results of this study showed that the perceived behavioral control constructs and subjective norms from the theory of planned behavior significantly explained the intention to reduce the consumption of sugar-sweetened beverages in students. It is recommended to design educational interventions to reduce the consumption of sugar-sweetened beverages among students based on this theory.زمینه و اهداف: مصرف بی‌رویه نوشیدنی‌های شیرین شده در بین دانش‌آموزان مقطع ابتدایی رو به افزایش است و با پیامدهای منفی سلامتی به ویژه بروز بیماری‌های مزمن در بزرگسالی ارتباط دارد. شناخت پیش‌بینی‌کننده‌های کاهش قصد مصرف این نوشیدنی‌ها، طراحی مداخلات موثرتر را ممکن می‌کند. مطالعه حاضر با هدف تعیین عوامل موثر بر قصد مصرف نوشیدنی‌های شیرین شده در دانش‌آموزان ابتدایی با استفاده از نظریه رفتار برنامه‌ریزی شده انجام شد. مواد و روش‌ها: اين مطالعه مقطعی-تحلیلی بر روي 300 دانش‌آموز مقطع ابتدايي شهر اراك انجام شد. دانش‌آموزان به صورت نمونه‌گيري خوشه‌ای انتخاب شدند. میزان لیوان/ روز مصرف نوشیدنی‌های شیرین شده دانش‌آموز و مادران آنها و سازه‌های نظریه رفتار برنامه‌ریزی شده جهت تعیین موثرترین سازه‌های پیشگویی‌کننده قصد کاهش مصرف نوشیدنی‌های شیرین شده در دانش‌آموزان با استفاده از پرسشنامه محقق ساخته بررسی شدند و با آزمون رگرسيون خطي تجزيه و تحليل انجام شد. رعایت ملاحظات اخلاقی در تمام مراحل اجرای مطالعه درنظر گرفته شد. یافته‌ها: میانگین سنی دانش‌آموزان 1/26±11/14 سال و ميزان مصرف نوشيدني شيرين آنها 2/59±3/86 ليوان در روز بود. کنترل رفتار درک شده (P<0/001, 0/55=β) و هنجارهای ‌ذهنی‌ (P<0/001, 0/25=β) پیشگویی‌کننده‌های قصد کاهش مصرف نوشیدنی‌های شیرین ‌شده بودند. ‌این متغیرها توانستند 49٪ واریانس قصد کاهش مصرف نوشیدنی‌های شیرین شده را پیشگویی کنند. نتیجه‌گیری: نتایج این مطالعه نشان داد، سازه‌های کنترل رفتاری درک شده و هنجارهای ذهنی از تئوری رفتار برنامه‌ریزی شده به طور معنی‌داری قصد کاهش مصرف نوشیدنی‌های شیرین شده را در دانش‌آموزان تبیین کردند. طراحی مداخلات آموزشی کاهش مصرف نوشیدنی‌های شیرین شده در بین دانش‌آموزان مبتنی بر این تئوری توصیه می‌گردد

Effects of iron on Vitamin D metabolism: A systematic review

Vitamin D is a prohormone nutrient, which is involved in skeletal and extra-skeletal functions. Iron is another essential nutrient that is necessary for the production of red blood cells and oxygen transport. This element plays important roles in enzymatic systems including those required for Vitamin D activation. To the best of our knowledge, there is no exclusive review on the relationship between iron deficiency anemia (IDA), as the most prevalent type of anemia, and Vitamin D deficiency and the effect of recovery from iron deficiency on Vitamin D status. The aim of this study was to conduct a systematic search of observational and clinical trials in this field. The databases of PubMed, ProQuest, Cochrane Library, ISI Web of Knowledge, and SCOPUS were searched comprehensively. English-language human studies conducted on iron deficient patients or interventions on the effect of iron therapy on Vitamin D were extracted (n = 10). Our initial search yielded 938 articles. A total of 23 papers met the inclusion criteria. Thirteen studies were excluded because they were not relevant or not defining anemia types. The final analysis was performed on ten articles (3 cross-sectional and 7 interventional studies). Observational data indicated a positive relationship between iron status and Vitamin D, while trials did not support the effectiveness of iron supplementation on improving Vitamin D status. The mechanism underlying this association may involve the reduction of the activation of hydroxylases that yield calcitriol. Future randomized controlled trials with large sample sizes and proper designs are needed to highlight underlying mechanisms

The effect of bitter almond (Amygdalus communis L. var. Amara) gum as a functional food on metabolic profile, inflammatory markers, and mental health in type 2 diabetes women: a blinded randomized controlled trial protocol

Abstract Background Using functional foods in the prevention and treatment of type 2 diabetes mellitus (T2DM) has increased across the world owing to their availability, cultural acceptability, and lower side effects. The present study will aim to examine the impact of bitter almond (Amygdalus communis L. var. Amara) gum as a functional food on metabolic profile, inflammatory markers, and mental health in women with T2DM. Methods We will conduct a randomized, triple-blind, placebo-controlled trial. A total of 44 women with T2DM will be randomly allocated into two groups: an intervention group (n = 20) and a placebo group (n = 20). Patients will receive either 5 g/d of bitter melon gum or a placebo for 8 weeks. Clinical and biochemical outcome parameters which include glycemic indices, lipid profile, inflammatory markers, oxidative stress indices, tryptophan (Trp), kynurenine (KYN), cortisol, glucagon-like peptide 1 (GLP-1), leptin, adiponectin, ghrelin, peroxisome proliferator-activated receptor (PPAR) gene expression, brain-derived neurotrophic factor (BDNF), endothelial cell adhesion molecules, plasminogen, cluster deference 4 (CD4), cluster deference 8 (CD8), anthropometric indices, blood pressure, dietary intake, and mental health will be measured at the baseline and end of the study. Statistical analysis will be conducted using the SPSS software (version 24), and P value less than 0.05 will be considered statistically significant. Discussion The present randomized controlled trial will aim to investigate any beneficial effects of bitter almond gum supplementation on the cardio-metabolic, immune-inflammatory, and oxidative stress biomarkers, as well as mental health in women with T2DM. Ethics and dissemination The study protocol was approved by the Ethical Committee of the Tabriz University of Medical Sciences (IR.TBZMED.REC.1399.726). Trial registration Iranian Registry of Clinical Trials ( www.irct.ir/IRCT20150205020965N7

Reference curves of anthropometric indices in two national studies conducted among Iranian children in 2003-2004 and 2009-2010: The Caspian study

Background: Reference percentile curves are usually used as a screening tool to determine growth disorders. Anthropometric indices are population-dependent and may differ according to ethnicity, dietary pattern and lifestyle habits. This study aims to compare the curves of anthropometric measures obtained in two national studies conducted among Iranian children and adolescents in 2003-2004 and 2009-2010. Materials and Methods: Anthropometric measures obtained in two nationwide surveys conducted in 10-18-year-old Iranian students were compared. Lambda-mu-sigma (LMS) Chart Maker Pro program was used to develop age- and gender-specific percentiles and to smooth and fit the model. Results: In 2003-2004, the mean and standard deviation (SD) of body mass index (BMI) and waist circumference (WC) were 18.98 ± 3.81 kg/m 2 and 67.50 ± 11.05 cm in boys; and 19.44 ± 3.78 kg/m 2 and 66.55 ± 9.89 cm in girls, respectively. In 2009-2010, the corresponding figures were 19.16 ± 4.07 kg/m 2 , 69.42 ± 11.43 cm, 19.63 ± 4.11 kg/m 2 , and 67.29 ± 9.69 cm, respectively. Height curves did not show considerable changes in two studies. Comparison of two series of studies showed that the weight, BMI, WC, and waist-to-height ratio were lower in adolescent girls than boys especially in higher percentiles. Moreover, in both genders, weight, BMI, and WC percentiles decreased. Conclusion: The growth charts of Iranian children and adolescents aged 10-18 years have changed over 5 years. The reference growth curves change over time in the pediatric age group, repeated surveys should be conducted to update the age- and gender-specific reference curves in different populations